Keywords

Critical illness is associated with increased protein catabolism that is resistant to nutritional support. There is some evidence that an acquired resistance to GH anabolic action appeared in these situations, may be partly responsible. Moreover, in the same conditions, IGF-I and IGFBP-3 serum levels concentrations are low, despite high circulating concentrations of GH. Among several critical illnesses, sepsis is one that GH/IGF-I axis has never systematically studied, and mainly in regard to its progression from uncomplicated sepsis to severe sepsis and/or septic shock. Thus, the aim of this study was to investigate the GH/IGF-I axis in septic phenomenon, especially with regard to its evolution. We measured, by commercially available radioimmunoassays (ELISA), the serum GH, IGF-I and IGFBP-3 levels of 59 septic patients (pts) (24 pts with sepsis [group G1], 12 severe sepsis pts [group G2], 23 pts with septic shock [group G3]) and we compared them with the findings of 15 healthy controls (group H). The definition of the stages of sepsis followed the criteria established by the ACCP/SCCM consensus conference (August 1992). We use one-way ANOVA to compare the results from sepsis, severe sepsis and septic shock patients with the ones from healthy controls. Results were as in the Table.

Table

Normal

Sepsis

Severe sepsis

Septic shock

P

GH (ng/Ml)

1.12 ± 0.56

5.58 ± 0.27

2.3 ± 1.1

6.3 ± 1.9b

0.013884

IGF-I (ng/mL)

170.9 ± 18.3

124.3 ± 18.6

91.7 ± 24.2

62.1 ± 7.6a,b

0.000163

IGHBP-3 (μg/Ml)

2.98 ± 0.14

1.98 ± 0.19a

1.73 ± 0.46a

1.38 ± 0.15a

0.000002

Data are mean ± standard error of mean, astatistically different from normal, bstatistically different from sepsis.

We conclude that GH/IGF-1 axis impairment increases in parallel with the increasing severity of septic process.